Discover our special guide to health insurance in South Africa
South Africa has one of the most advanced healthcare systems on the African continent. Its latest major healthcare initiative is the introduction of universal health coverage, initially targeted for 2025. In the meantime, access to healthcare remains highly unequal under the current system. Expatriate health insurance gives you the freedom to choose where you receive care, with reimbursement levels suited to the private sector, which generally best matches the healthcare habits and expectations of expatriates.
| Health care expenditure per capita | € 500 |
| Annual indexing of health care expenses | 8.77% |
| CFE hospitalization reimbursement rate | 50% |
| Number of insurance companies providing services | 21 |
| Cost of hospital coverage for people 30 years old/year | € 744 |
| Cost of hospital coverage for people 50 years old/year | € 1476 |
South Africa's healthcare system is widely regarded as the most developed in Africa, offering a high standard of care in both the public sector, particularly through teaching hospitals, and the private sector. As a result, the country has become a leading medical tourism destination on the continent, offering reasonable value for money to patients who can afford to pay out of pocket. It's private healthcare infrastructure also attracts many of the region's leading physicians.
However, access to healthcare varies considerably across the country. Only around 20% of the population has access to the high-quality care provided by the private sector, while healthcare facilities are concentrated in major cities and popular tourist destinations such as Cape Town, Johannesburg, Pretoria and Durban.
In an effort to reduce these inequalities and improve access to healthcare for the entire population, regardless of socioeconomic status, the government launched a reform in 2017 to create a National Health Insurance (NHI) system. The aim is to provide universal health coverage while ensuring consistent standards of care across the public and private sectors, modernizing infrastructure and improving the distribution of healthcare professionals.
To date, the NHI's funding and implementation arrangements remain unclear, although a launch target of 2025–2026 was initially set. Employer and employee contributions are expected to be the primary source of funding, while private health insurance would focus on covering healthcare expenses not reimbursed by the NHI.
The South African healthcare system is characterized by significant disparities between the public and private sectors. The public sector serves more than 71.5% of the population, despite facing a number of challenges, including insufficient funding, a shortage of healthcare professionals, inadequate equipment and overcrowded facilities. The private sector provides coverage for 10.1 million people who can afford to contribute to a medical aid scheme.
The public healthcare system is funded by the government. It includes 422 hospitals, which provide the majority of healthcare services and are often overcrowded, resulting in lengthy waiting times. Healthcare is not entirely free of charge: patient contributions are determined according to income and the number of dependents. Lower-income patients may benefit from reduced out-of-pocket costs or free healthcare. Expatriates, on the other hand, are generally required to pay the highest contributions.
The National Department of Health manages the country's 10 major teaching hospitals, which are renowned for the quality of their care. These include Chris Hani Baragwanath Hospital in Soweto, the largest hospital in the Southern Hemisphere, with 3,200 beds and internationally recognized standards of care. Approximately 70% of admissions are emergencies, with the emergency department seeing up to 350 patients a day. Regional hospitals are overseen by the Provinces, while smaller hospitals and primary care clinics are managed at District level.
Although the private sector has fewer hospitals than the public sector (215 compared with 422), it brings together nearly 40% of the country's general practitioners and nurses. Higher salaries and better working conditions, combined with high-quality facilities and state-of-the-art equipment, attract healthcare professionals from South Africa and neighboring countries. However, this higher standard of care comes at a cost. Only the wealthiest members of the population can afford private healthcare and typically take out health insurance to cover the high cost of treatment.
Whether you use the public or private healthcare system, you are generally free to choose your doctor in South Africa. However, you may be required to use a specific healthcare network. Healthcare providers may have agreements with local insurance companies that restrict patients' choice of doctors and medical facilities, depending on the terms of their policy.
This is why it is important to check which network and in-network healthcare providers are covered by an insurance policy before taking out local health insurance. International health insurance offers the advantage of allowing you to choose your doctors and healthcare facilities freely.
A general practitioner consultation costs approximately USD 30, while a specialist consultation costs an average of USD 70. Depending on the doctor's location and specialty, a private-sector GP consultation can cost as much as USD 80, while a specialist consultation can reach USD 200. It is important to note that the vast majority of doctors work in the private sector. This generally means shorter waiting times and greater access to medical specialties than in the public sector, which is often described as being severely understaffed and under-resourced.
You can see a specialist without first consulting a GP, although a general practitioner is still often the patient's first point of contact. Appointments must generally be scheduled in advance, except in emergencies. Consulates often provide lists of doctors, making it easier for expatriates to find healthcare professionals who speak their native language.
Healthcare services in South Africa often have to be paid for upfront. Since 2000, the prices of certain healthcare services in public hospitals have been set according to the Uniform Patient Fee Schedule (UPFS). The patient's out-of-pocket costs then depend on their socioeconomic category. Three categories are generally distinguished: fully paying patients, fully subsidized patients and partially subsidized patients. In the private sector, however, patients are responsible for the full cost of care, making health insurance essential given the high fees charged.
The cost of a hospital stay varies depending on several factors, including the type of hospital, the procedure performed, the type of room and the services required. In the public sector, costs are relatively low, averaging between 1,000 and 2,000 rand per day. In the private sector, costs can range from 2,500 to 20,000 rand or more per day, depending on the facility and the treatment provided. For example, an appendectomy can cost between 21,000 and 120,000 rand at a private hospital, based on a two-day hospital stay.
When it comes to medication, South Africa has two main pharmacy chains, Clicks and Dis-Chem, which are often located in hospitals and shopping malls, as well as numerous independent pharmacies. The country's pharmacy sector is highly developed and efficient, particularly when it comes to vaccines. Some common medications, such as paracetamol, are sold directly in supermarkets. Pharmacists are also authorized to provide basic medical advice.
Dental care costs vary depending on the provider and facility you choose. Basic procedures such as a dental cleaning or filling generally cost between 600 and 2,500 rand. Dental implants can cost between 20,000 and 200,000 rand, while a crown costs at least 3,000 rand.
Public healthcare is free for pregnant women and children under the age of six. However, many expatriates prefer to use private hospitals and clinics to benefit from a higher standard of care. In the private sector, the cost of a vaginal delivery with a three-day hospital stay can range from 25,000 to 80,000 rand.
Cesarean sections are common in South Africa. It is important to discuss your preferred delivery method in advance, as you may not always have a choice when the time comes. At a private clinic, a C-section costs approximately 40,000 rand, excluding hospital fees. The total cost of a hospital stay involving a cesarean section can reach 100,000 rand or more, depending on the complexity of the procedure and the level of care required.
To limit your out-of-pocket costs, taking out health insurance is essential if you plan to give birth in the private sector. You should also be aware that the choice of delivery facility is generally determined by the gynecologist or obstetrician you have selected. Conversely, if you choose a specific facility, a doctor will generally be assigned to you automatically.
There is no bilateral Social Security agreement between France and South Africa.
French Social Security only covers French tourists in South Africa during short stays of up to 90 consecutive days. Coverage may apply in the event of an unexpected illness and is limited to the amount that would have been reimbursed under the French Social Security system.
French Social Security does not cover temporary residents staying in South Africa for more than three months or permanent residents of the country.
The best way to maintain a connection with the French Social Security system is to enroll with the Caisse des Français de l'Étranger (CFE), which provides coverage for healthcare, disability and life benefits, and even retirement.
CFE health insurance reimburses medical, surgical, hospital, dental, optical, laboratory and other healthcare expenses, subject to the reimbursement rates and fee schedules applicable to Zone 2 under the CFE's coverage system.
The CFE covers healthcare expenses incurred in South Africa in much the same way as French Social Security, providing a first layer of reimbursement. For example, the reimbursement basis for a pharmacy bill may be 65% of the bill, leaving the remaining 35% to be paid out of pocket.
It is up to you to determine your needs and decide whether CFE coverage alone is sufficient, with the out-of-pocket costs this may entail, or whether you would prefer to combine it with supplemental international health insurance or choose first-euro coverage. Expatriate health insurance taken out alongside the CFE, or on a first-euro basis, can provide 100% coverage for hospitalization at the hospital of your choice, as well as additional reimbursement for routine healthcare expenses, particularly for those looking for strong optical and dental coverage.
CFE contributions are calculated based on your age and whether you are enrolling alone or covering two or more people. CFE members can therefore remain covered in France and internationally and can quickly regain their rights under the French CPAM system when they permanently return to France.
Three major groups dominate South Africa's private hospital market: Netcare, Life Healthcare and Mediclinic. Together, they account for 90% of inpatient stays and 83% of private-sector hospital bed capacity, and are estimated to hold approximately 75% of the private healthcare market.
Alongside these hospital groups, local health insurance is primarily provided through organizations known as Medical Aid schemes or Medical Schemes, including Discovery Health, Medihelp Insurance, Momentum Health, Fedhealth and Liberty Health.
These organizations offer a broad range of health plans, from emergency-only and basic options to comprehensive coverage, depending on each individual's budget and healthcare needs. However, the most affordable plans may only provide access to doctors and hospitals within specific provider networks. To have greater freedom to choose your healthcare providers, you generally need to pay more for your coverage.
Premiums vary considerably depending on the level of coverage selected, the insured person's age and their medical history. Policies may include exclusions for pre-existing conditions and waiting periods for certain benefits.
Employers are not required to provide health insurance coverage. In some cases, you may therefore need to purchase a policy privately. If your employer does offer health insurance, it is important to carefully review the benefits and provider network to ensure that they meet your expectations and healthcare needs.
Created in 2005, the South African Social Security Agency (SASSA) is responsible for distributing social benefits to older people, war veterans, children and orphans, as well as people with limited financial resources and people with disabilities. These benefits are funded through taxes and insurance contributions and are allocated to residents whose income falls below certain thresholds. The income tax rate for residents ranges from 18% to 41%, depending on the applicable tax bracket.
Healthcare, overseen by the Department of Health, provides primary healthcare services in public hospitals to all South African citizens and permanent residents, with out-of-pocket costs calculated according to the Uniform Patient Fee Schedule (UPFS) and the patient's socioeconomic status.
Travelers holding a student visa or temporary work visa are considered permanent residents for healthcare purposes and may qualify for one of the subsidized categories, depending on their financial resources. Expatriates and travelers who have not yet obtained permanent resident status, or who are staying in South Africa under another type of visa, may receive treatment in the public sector but must pay the full UPFS fees as fully paying patients.
UPFS charges vary according to two criteria: the healthcare facility (facility fee) and the healthcare professional (professional fee). Level 1 healthcare providers are less expensive than Level 2 or Level 3 providers, while medical procedures and services are categorized from the least expensive (Category A) to the most expensive (Category E).
For example, in the Western Cape province, a Level 1 facility fee for an X-ray at a Level 1 or Level 2 hospital may be 91 rand, compared with 101 rand at a Level 3 facility. Additional specialist fees range from 166 rand for Category A services to 5,672 rand for Category B services.
Healthcare costs can therefore be high in the public sector for both South African residents and non-residents classified as fully paying patients, depending on the type of treatment and the level of healthcare provider chosen.
For residents who fall into the subsidized patient categories, the level of government assistance is determined according to four income brackets, based on the example of the Western Cape:
The same pricing principle that applies to fully paying patients also applies here. UPFS fees for partially subsidized patients vary according to the level of the healthcare facility (1, 2 or 3) and the category of medical service (A to E).
Expatriates often have incomes above the thresholds required to qualify as subsidized patients and therefore generally have to pay the full UPFS fees. In such cases, private health insurance may be the only way to obtain meaningful coverage for these healthcare costs.
Unemployment, sickness and maternity benefits are managed by the Department of Employment and Labour. These benefits are based on contributions paid to SASSA and related insurance schemes.
As part of the rollout of the NHI, the Department of Social Development proposed the creation of a new national social security fund in 2021 to cover retirement benefits, disability pensions and unemployment benefits. However, the proposed tax to fund the scheme, which could have reached 12% of income, was considered too high and the project was withdrawn.
While South Africa awaits the implementation of universal health insurance, expatriates are well advised to take out private health insurance to help cover the high cost of healthcare, particularly in the private sector.
Certain types of visas, including work, student and temporary residence visas, may require proof of health insurance. Local health insurance plans may have limitations or residency requirements that make it difficult for expatriates to qualify. In such cases, choosing international health insurance can provide comprehensive coverage and much more.
The high cost of private healthcare and the difficulties involved in accessing care through the public sector make private health insurance an important consideration. With expatriate health insurance, you benefit from considerable freedom when choosing your healthcare providers, reimbursement levels suited to the expenses you want to cover—including optical and dental care, alternative medicine, private hospital rooms and more—and the peace of mind of remaining covered in your home country if you wish to continue seeing certain doctors or maintain your usual healthcare arrangements.
Choosing an expatriate health insurance policy means choosing both security and flexibility. You benefit from experienced points of contact and a clear legal framework governing your insurance policy. It also means direct payment of 100% of eligible hospitalization expenses, as well as benefits such as telemedicine, medical evacuation and repatriation assistance.
In addition, expatriate health insurance can provide emergency medical coverage internationally during occasional personal or business trips.
An expatriate health insurance policy can be taken out at any time. International insurance plans are flexible and modular, allowing you to select only the options that are relevant to you. The benefits are similar to those you may already be familiar with, helping to avoid uncertainty about how the local healthcare system works.
Applying for expatriate health insurance is generally more involved than enrolling in a standard local health plan. It is therefore advisable to start the process at least 30 days before your departure or your desired policy effective date.
When applying for expatriate health insurance, you will usually be asked to complete a medical questionnaire. Depending on your medical history, further discussions with the insurer's medical underwriting team may be required, which can take some time. You may also be asked to provide additional medical documents, so it is advisable to have your medical records readily available. In some cases, your treating physician may need to complete a questionnaire relating to a specific medical condition.
On our website, you can obtain online quotes and compare the different benefits available. This gives you a clear overview of the available options and helps you choose the policy that best matches your needs.
Once you have completed your research and have a clearer idea of what you are looking for, our advisors are available to refine the options, help you finalize your choice and guide you throughout the application process. They can answer your questions, provide additional information and assist you with each step of the enrollment process.
Your advisor can also check that the policy you select is accepted and recognized by the relevant authorities.
Universal health coverage has not yet been implemented, and the conditions for accessing care in the public sector are neither optimal nor entirely free of charge. If you want access to private healthcare and the freedom to choose your doctors and healthcare facilities, you should consider an expatriate health insurance plan that covers both hospitalization and routine medical care.
This type of coverage also allows you to continue seeing your usual doctors when visiting France, cover healthcare expenses that you prefer to incur in France, and remain covered in the event of an emergency or accident during occasional trips abroad.
If you have more room in your healthcare budget and expect to have regular expenses in these areas, consider a plan that also covers optical and dental care. Although these services may be more affordable than in France, they can still represent significant out-of-pocket expenses in South Africa.
Finally, expectant mothers should remember to add maternity coverage well in advance. Expatriate insurers typically apply waiting periods of between 9 and 12 months, and insurers will not generally cover a pregnancy that was already in progress when the policy was taken out.
This coverage is particularly important given the uneven availability of healthcare services across the country. Medical evacuation and repatriation assistance can arrange transportation, under appropriate medical conditions, to the hospital best suited to your medical condition. It can also help you find healthcare facilities with high-quality equipment and doctors trained in the latest medical techniques.
These assistance services can also provide what might be described as additional support services, which can be invaluable in a difficult situation. For example, they may cover the cost of travel for a family member to visit you in hospital, arrange childcare or the transportation of children, and provide access to medical advice and second opinions.
As a reminder, in the event of a medical emergency, neither your embassy nor your consulate is responsible for arranging or paying for medical repatriation. If you do not want to bear the cost yourself—which can reach tens of thousands of euros—hospitalization coverage combined with medical evacuation and repatriation assistance is the minimum level of protection recommended for any traveler or expatriate in South Africa.
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